326 DB NOVO ORIGIN OF BACTERIA 



been discovered, can be referred to a chronic inflammatory process. 

 He said : " The so-called tuberculous process in the external lym- 

 phatic glands can often be traced to some simple inflammatory 

 process that implicates the radicles of the gland. Here the first 

 change communicated to the gland is essentially inflammatory 

 and as that change develops in the organ it begins to assume 

 peculiar features." Of course, it would novi^ be said, Yes, what 

 you say may be true, but the irritative or inflammatory influence, 

 the effects of which you recognise, is really due to, and caused by, 

 the presence of the tubercle Bacillus. To this it may fairly be 

 rejoined that such a view ignores the real and often obvious cause 

 — the irritation of the gland ; that it ignores the general state of 

 the system which pre-exists and co-operates ; and that it postulates 

 infection without proof as the initial cause of the whole phenomena. 

 But in the absence of any rational or even plausible means of ac- 

 counting, in accordance with contagionist theories, for the presence 

 of tubercle bacilli in certain lymphatic glands and in these alone, or 

 in some joint and nowhere else in the body, it is, I think, most in 

 harmony with existing knowledge to suppose that this particular 

 Bacillus is a product rather than a cause of certain inflammations 

 occurring in lowly vitalised subjects, in just the same way that the 

 appearance of the Bacillus of " Pasteur's septicaemia " seems, as 

 Burdon Sanderson put it, dependent "on the intensity of the 

 inflammation itself." The adoption of such a view would go far 

 to explain many difficulties ; and the question of the etiology of 

 tuberculous affections would be greatly simplified and brought 

 again more closely into accord with former views.' 



Quite recently, however, von Behring has been advocating a 

 very different hypothesis.'' He believes that infection takes place 

 in the main in infancy, through the intestinal canal, and that 

 thereafter the infecting Bacilli lodging in different parts of the 

 body commonly remain latent for years, perhaps for a long series 

 of them. He relies in part upon recent investigations showing the 

 high percentage of cases in which tuberculous lesions of some kind 

 are to be found at necropsies, or demonstrated during life by 

 tuberculin and other means ; aqd in part upon his own researches 

 demonstrating that tubercle Bacilli can, in infancy more especially, 

 easily pass from the intestine into the lacteals and thence into the 



' See " Brit. Med. Jrnl.," Aug. 19, 1905, p. 388, concerning the occurrence of 

 the Bacillus of tubercle in lymphatic glands. 

 ' "Deut. Medicin. Wochen.," Sept. 24, 1903. 



